Nigella Sativa: A Powerful Adjunct to Comprehensive Hashimoto’s Treatment
Kaycie Rosen Grigel, ND
Vis Medicatrix Naturae
Nigella sativa, a lovely plant native to the Middle East, is currently gaining increased attention throughout the world for its ability to decrease inflammation and improve patient outcomes for many chronic disease processes. There is data to indicate that it is similarly useful in the treatment of autoimmune thyroid disease, in particular Hashimoto’s thyroiditis. In this article we will look not only at how this plant can be useful in this context, but also how to incorporate it into the Therapeutic Order as we create a comprehensive plan for our patients.
Identify Contributing Factors
When treating any patient, including those with Hashimoto’s thyroiditis, we always want to consider what factors have contributed to the system falling out of balance. As naturopathic doctors, we know that before we implement specific strategies that target an ailing organ system, we want to holistically address any underlying imbalance. Conventional treatment for Hashimoto’s is generally similar to any other case of hypothyroidism. However, we know that the autoimmune component indicates an underlying inflammatory process. Understanding this process and being able to address it gives us the opportunity to treat patients with greater specificity.
As we all know, the initiating factor(s) in autoimmune disease can be variable and challenging to pinpoint, and the process of identifying and correcting them is quite individualized. In addition to thyroid hormone replacement therapy, holistic treatment for autoimmune thyroid issues will often be multipronged, and may address dietary and lifestyle factors as well as utilizing natural therapies to support the thyroid and decrease the inflammatory process.
Creating a comprehensive plan for patients is much simpler when we take a methodical approach that includes all of the determinants of health: Stress and how the patient interprets and copes with stressors, environmental exposures, nutritional excesses and deficiencies, and sleep patterns all play important roles in the development of autoimmune thyroiditis. We can fine-tune our data by looking at food sensitivity panels, thyroid-specific nutrient panels, and environmental toxicity panels. This helps us to individualize our food and nutrient advice, as well as to determine the appropriateness of any specific detoxification protocol, counseling, bodywork, and/or stress management therapies. We can then pair the protocol with our thyroid support or replacement of choice. By so doing, we can help to decrease the tendency toward inappropriate inflammation and give the body the tools it needs for healing. Our treatment protocol can be even more powerful, though, if we use therapies that specifically target the inflammatory response.
Hashimoto’s, which is frequently accompanied by other autoimmune disorders, is becoming better understood as just one manifestation of systemic immune dysregulation.1,2 Because of this, one critical component of comprehensive autoimmune thyroid support is specifically addressing the integrity of the immune system. In addition to our more common natural anti-inflammatory and immune-modulating strategies, Nigella sativa can help to fill an important niche in a comprehensive approach to healing Hashimoto’s thyroiditis.
Nigella sativa & Inflammation
Nigella sativa is an annual flower in the buttercup family, and has a range of common names, including black cumin, onion seed, and black seed. It has been used as a culinary spice and medicine in Asia and the Middle East for thousands of years. Nigella is mentioned in the Bible, and there is an Islamic belief that it can prevent any malady except death. It also has traditional use in Ayurvedic medicine. The 2 primary ways in which Nigella can help control Hashimoto’s are by modulating inflammation and improving fat metabolism.
Many studies conducted over the past 2 decades have shown that Nigella sativa can positively impact a wide range of diseases. Thymoquinone is one of the primary active constituents isolated from Nigella sativa. Thymoquinone on its own, as well as whole plant preparations of Nigella, has been shown to act as a potent antioxidant and anti-inflammatory in many bodily systems and disease patterns, including cancer, diabetes, hyperlipidemia, allergies, and other autoimmune diseases.3-12 As examples, supplementation with Nigella oil led to a decrease in overall biomarkers of inflammation in a trial of obese women.13 Topical Nigella oil demonstrated comparable efficacy as betamethasone in eczema.14 A dose of 1-2 gram/day of the ground seed was shown to improve measures of pulmonary function and lung inflammation in controlled asthma patients.15 Finally, in one study, 500 mg twice daily of Nigella oil improved joint swelling and morning stiffness in rheumatoid arthritis (RA) patients; in another trial, the same dose improved biomarkers of inflammation in RA.16,17
Nigella sativa & Autoimmune Thyroiditis
While studies demonstrate a general trend of Nigella to reduce inflammation in many conditions, more recent information is emerging that shows Nigella to be useful specifically in thyroid conditions. One mechanism appears to be its positive impact on the gut, which can be an underlying factor in autoimmune thyroid issues. Because the GI tract is our primary line of defense against the outside world, it will often manifest the first signs of immune or inflammatory dysfunction.
For example, the association between celiac disease and Hashimoto’s thyroiditis is well known. Hashimoto’s patients have also often been found to have a greater incidence of changes to gut epithelial cells, abnormal intestinal permeability, and lymphocyte infiltration into the lining of the gut.18 Nigella has extensive historical and folk use in healing the digestive tract: An Iranian-trained medical doctor mentioned to me that she was taught to use Nigella for heartburn and other digestive maladies. Clinical trials have found Nigella to be useful for colitis and gastritis and to have equivalent efficacy as triple therapy in the treatment of Helicobacter pylori infection.19 By reducing inflammation and infection in the gut, Nigella can theoretically help to reduce systemic inflammation and the tendency toward autoimmune reactivity.
The underlying inflammation in autoimmune thyroid disease is often correlated with glucose and lipid metabolism irregularities. One of the primary complaints in Hashimoto’s thyroiditis is unexplained weight gain, and elevated TSH levels are often correlated with less favorable lipid profiles.20 While this decrease in metabolism can be partially explained by a decrease in thyroid hormone levels, the research suggests that it is also associated with the inflammatory process itself. In a study of 372 postmenopausal women, they found that “Obese subclinical hypothyroid women with Hashimoto`s thyroiditis have a higher prevalence of metabolic syndrome when compared with subclinical hypothyroid women without thyroid autoimmunity. It is possible that in the crosstalking between subclinical hypothyroidism and metabolic syndrome, enhanced proinflammatory cytokine release in the course of immunological thyroiditis plays a role.”21 Several studies have shown Nigella’s ability to improve glucose and lipid metabolism, including a positive impact on metabolic syndrome, insulin resistance, diabetes, and polycystic ovary syndrome (PCOS).22-25 Nigella also has been shown to assist with weight loss and to increase superoxide dismutase in obese women.26
Considering the body of research on this plant, there is a compelling theoretical reason to apply it to treatment of Hashimoto’s. To date, there has only been 1 human trial, released in 2016, studying the role of Nigella in Hashimoto’s; however, it demonstrated promising results.27 Forty patients with Hashimoto’s were divided into 2 groups and treated with either Nigella or placebo. Women with Hashimoto’s thyroiditis who took 1 gram/day of the ground seed for 8 weeks saw a significant improvement in both anthropometric and blood level measures compared to placebo. Anthropometric measurements included: body weight, body mass index (BMI), waist circumference (WC), hip circumference (HC), and waist-to-hip ratio (WHR). Participants in the Nigella group also experienced an overall reduction in serum TSH (6.42 +/-3.86 to 4.13 +/- 2.35) and anti-TPO antibodies (294.35 +/- 210 to 147.99 +/-158.33) and an increase in T3 levels. Concentrations of vascular endothelial growth factor (VEGF) also decreased overall and were found to be dependent upon changes in WHR. No such changes were observed in the placebo group.
The antioxidant and anti-inflammatory actions of Nigella likely contributed to the positive outcome of this study via a few proposed mechanisms. One is increased lipolysis and decreased lipogenesis secondary to a decrease in VEGF; thymoquinone has been found in in-vitro and animal studies to decrease VEGF levels.28-29 Increased VEGF has been observed in people with chronic thyroiditis and thyroid cancer, and increased TSH levels are known to increase production of VEGF.30,31 Increased VEGF is also associated with metabolic syndrome and obesity, as it expands vasculature to the adipose tissue. The authors of the study mentioned above27 postulate that by decreasing VEGF, blood supply to the thyroid and adipose tissue decreases as well, which has the effect of decreasing inflammation in the thyroid and shrinking fat stores. Thymoquinone has also been shown to increase heme-oxygenase, which decreases inflammation, particularly in the vascular endothelium. This in turn will decrease inflammation in the thyroid, leading to a decrease in anti-TPO antibodies and an increase in T3 levels.32,33
Nigella sativa has extensive historical use as a culinary and medicinal herb, and is generally regarded as safe for internal consumption. This plant has low toxicity and has been reported as well tolerated. While it is somewhat less common to find as a supplement, some commercially prepared products of both the oil and the ground seed are available in the United States. The whole seeds can also be readily found at Middle Eastern and Indian supermarkets. While Nigella is a very low toxicity plant, it is nonetheless important to watch for and educate patients about the possibility of hypersensitivity reactions. There have been case reports that some people do not digest it well. In the study mentioned above,27 3 of the original 23 participants in the treatment group dropped out at the start of the study because they developed a rash. This is a fairly large proportion of test subjects to exhibit signs of sensitivity, and there have been other reports of hypersensitivity reactions to topical Nigella sativa applications.34,35 Thus, when using this plant, it would be prudent to advise patients to be on the lookout for any signs of intolerance or hypersensitivity.
As we go through our Therapeutic Order (Table 1) to establish a process for restoring balance to the system as a whole, we should keep in mind that Nigella sativa can play an useful role in modifying the inflammatory process that can throw the thyroid out of balance. It decreases inflammation, helps to reduce TSH and anti-TPO antibodies, and raises T3. It also helps to reverse some of the weight gain associated with hypothyroidism. Nigella can be used as a powerful piece of a holistic approach to bringing the endocrine and immune systems back to a state of optimal health.
Table 1. Using the Therapeutic Order in Hashimoto’s Treatment
|The Therapeutic Order (lowest to highest intervention)||Possible Therapies in Hashimoto’s Thyroiditis (a non-exhaustive list)|
|Remove Obstacles to Health Using the Determinants of Health||· Identify and address sources of stress
· Establish healthy sleep patterns
· Identify inflammatory foods in the diet, and counsel on appropriate dietary habits
· Identify and remove environmental exposures that may be impacting the endocrine system
|Stimulate the Body’s Innate Ability to Heal||· Use specific nutrients to nourish the thyroid (eg, iodine, selenium)
· Use treatments that stimulate the Vis Medicatrix Naturae (eg, constitutional hydrotherapy, craniosacral therapy)
· Counsel on appropriate exercise to reduce stress, boost metabolism, decrease inflammation, and improve circulation (individualize, but consider activities such as yoga and “forest bathing”-type exercise like hiking)
|Support and Restore Weakened Systems||· Thyroid-specific botanical support (eg, bladderwrack, thyroid hormone-free glandulars)
· Anti-inflammatory herbs (eg, Nigella sativa, turmeric)
· Patient-specific detoxification protocols
|Re-establish Physical Alignment||· Bodywork to decrease areas of inflammation in the body
· Counsel on light thyroid massage
|Use Natural Substances to Control Symptoms||· Natural hormone preparations (eg, Nature-Throid, Armour)|
|Use Synthetic Substances to Control Symptoms||· Synthetic thyroid hormone (eg, Synthroid, levothyroxine, Tirosint, Cytomel)|
- Wémeau JL, Proust-Lemoine E, Ryndak A, Vanhove L. Thyroid autoimmunity and polyglandular endocrine syndromes. Hormones (Athens). 2013;12(1):39-45.
- Bliddal S, Nielsen CH, Feldt-Rasmussen U. Recent advances in understanding autoimmune thyroid disease: the tallest tree in the forest of polyautoimmunity. F1000Res. 2017;6:1776.
- Badar A, Kaatabi H, Bamosa A, et al. Effect of Nigella sativa supplementation over a one-year period on lipid levels, blood pressure and heart rate in type-2 diabetic patients receiving oral hypoglycemic agents: nonrandomized clinical trial. Ann Saudi Med. 2017;37(1):56-63.
- Khader M, Eckl PM. Thymoquinone: an emerging natural drug with a wide range of medical applications. Iran J Basic Med Sci. 2014;17(12):950-957.
- Majdalawieh AF, Fayyad MW. Immunomodulatory and anti-inflammatory action of Nigella sativa and thymoquinone: A comprehensive review. Int Immunopharmacol. 2015;28(1):295-304.
- Darakhshan S, Bidmeshki Pour A, Hosseinzadeh Colagar A, Sisakhtnezhad S. Thymoquinone and its therapeutic potentials. Pharmacol Res. 2015;95-96:138-158.
- Gholamnezhad Z, Havakhah S, Boskabady MH. Preclinical and clinical effects of Nigella sativa and its constituent, thymoquinone: A review. J Ethnopharmacol. 2016;190:372-386.
- Sabzghabaee AM, Dianatkhah M, Sarrafzadegan N, et al. Clinical evaluation of Nigella sativa seeds for the treatment of hyperlipidemia: a randomized, placebo controlled clinical trial. Med Arch. 2012;66(3):198-200.
- Gheita TA, Kenawy SA. Effectiveness of Nigella sativa oil in the management of rheumatoid arthritis patients: a placebo controlled study. Phytother Res. 2012;26(8):1246-1248.
- Işik H, Cevikbaş A, Gürer US, et al. Potential adjuvant effects of Nigella sativa seeds to improve specific immunotherapy in allergic rhinitis patients. Med Princ Pract. 2010;19(3):206-211.
- Ahmad A, Husain A, Mukeeb M, et al. A review on therapeutic potential of Nigella sativa: a miracle herb. Asian Pac J Trop Biomed. 2013;3(5):337-352.
- Salem, ML. Review: Immunomodulatory and therapeutic properties of the Nigella sativa L. seed. Int Immunopharmacol. 2005;5(13-14):1749-1770.
- Mahdavi R, Namazi N, Alizadeh M, Farajnia S. Nigella sativa oil with a calorie-restricted diet can improve biomarkers of systemic inflammation in obese women: A randomized double-blind, placebo-controlled clinical trial. J Clin Lipidol. 2016;10(5):1203-1211.
- Yousefi M, Barikbin B, Kamalinejad M, et al. Comparison of therapeutic effect of topical Nigella with Betamethasone and Eucerin in hand eczema. J Eur Acad Dermatol Venereol. 2013;27(12):1498-1504.
- Salem AM, Bamosa AO, Qutub HO, et al. Effect of Nigella sativa supplementation on lung function and inflammatory mediatorsin partly controlled asthma: a randomized controlled trial. Ann Saudi Med. 2017;37(1):64-71.
- Gheita TA, Kenawy SA. Effectiveness of Nigella sativa oil in the management of rheumatoid arthritis patients: a placebo controlled study. Phytother Res. 2012;26(8):1246-1248.
- Hadi V, Kheirouri S, Alizadeh M, et al. Effects of Nigella sativa oil extract on inflammatory cytokine response and oxidative stress status in patients with rheumatoid arthritis: a randomized, double-blind, placebo-controlled clinical trial. Avicenna J Phytomed. 2016;6(1):34-43.
- Mori K, Nakagawa Y, Ozaki H. Does the gut microbiota trigger Hashimoto’s thyroiditis? Discov Med. 2012;14(78):321-326.
- Salem EM, Yar T, Bamosa AO, et al Comparative study of Nigella Sativa and triple therapy in eradication of Helicobacter Pylori in patients with non-ulcer dyspepsia. Saudi J Gastroenterol. 2010;16(3):207-214.
- Asvold BO, Vatten LJ, Nilsen TI, Bjøro T. The association between TSH within the reference range and serum lipid concentrations in a population-based study. The HUNT Study. Eur J Endocrinol. 2007;156(2):181-186.
- Siemińska L, Wojciechowska C, Walczak K, et al. Associations between metabolic syndrome, serum thyrotropin, and thyroid antibodies status in postmenopausal women, and the role of interleukin-6. Endokrynol Pol. 2015;66(5):394-403.
- Amin F, Islam N, Anila N, Gilani AH. Clinical efficacy of the co-administration of Turmeric and Black seeds (Kalongi) in metabolic syndrome – a double blind randomized controlled trial – TAK-MetS trial. Complement Ther Med. 2015;23(2):165-174.
- Ibrahim RM, Hamdan NS, Mahmud R, et al. A randomised controlled trial on hypolipidemic effects of Nigella Sativa seeds powder in menopausal women. J Transl Med. 2014;12:82.
- Sahebkar A, Beccuti G, Simental-Mendía LE, et al. Nigella sativa (black seed) effects on plasma lipid concentrations in humans: A systematic review and meta-analysis of randomized placebo-controlled trials. Pharmacol Res. 2016;106:37-50.
- Karaköse M, Hepsen S, Çakal E, et al. Frequency of nodular goiter and autoimmune thyroid disease and association of these disorders with insulin resistance in polycystic ovary syndrome. J Turk Ger Gynecol Assoc. 2017;18(2):85-89.
- Namazi N, Mahdavi R, Alizadeh M, Farajnia S. Oxidative Stress Responses to Nigella sativa Oil Concurrent with a Low-Calorie Diet in Obese Women: A Randomized, Double-Blind Controlled Clinical Trial. Phytother Res. 2015;29(11):1722-1728.
- Farhangi MA, Dehghan P, Tajmiri S, Abbasi MM. The effects of Nigella sativa on thyroid function, serum Vascular Endothelial Growth Factor (VEGF)-1, Nesfatin-1 and anthropometric features in patients with Hashimoto’s thyroiditis: a randomized controlled trial. BMC Complement Altern Med. 2016;16(1):471.
- Zhang L, Bai Y, Yang Y. Thymoquinone chemosensitizes colon cancer cells through inhibition of NF-κB. Oncol Lett. 2016;12(4):2840-2845.
- Al-Trad B, Al-Batayneh K, El-Metwally S, et al. Nigella sativa oil and thymoquinone ameliorate albuminuria and renal extracellular matrix accumulation in the experimental diabetic rats. Eur Rev Med Pharmacol Sci. 2016;20(12):2680-2688.
- Klein M, Picard E, Vignaud JM, et al. Vascular endothelial growth factor gene and protein: strong expression in thyroiditis and thyroid carcinoma. J Endocrinol. 1999;161(1):41-49.
- Soh EY, Sobhi SA, Wong MG, et al. Thyroid-stimulating hormone promotes the secretion of vascular endothelial growth factor in thyroid cancer cell lines. Surgery. 1996;120(6):944-947.
- Calay D, Mason JC. The multifunctional role and therapeutic potential of HO-1 in the vascular endothelium. Antioxid Redox Signal. 2014;20(11):1789-1809.
- Kundu J, Kim DH, Kundu JK, et al. Thymoquinone induces heme oxygenase-1 expression in HaCaT cells via Nrf2/ARE activation: Akt and AMPKα as upstream targets. Food Chem Toxicol. 2014;65:18-26.
- Gelot P, Bara-Passot C, Gimenez-Arnau E, et al. Bullous drug eruption with Nigella sativa oil. Ann Dermatol Venereol. 2012;139(4):287-291.
- Zaoui A, Cherrah Y, Mahassini N, et al. Acute and chronic toxicity of Nigella sativa fixed oil. Phytomedicine. 2002;9(1):69-74.
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Kaycie Rosen Grigel, ND, is a naturopathic doctor who specializes in endocrinology, digestion, and family health. She graduated magna cum laude from the University of Colorado at Boulder, and received her Doctor of Naturopathic Medicine from Bastyr University in Seattle, WA. She practiced in Anchorage, AK, before returning to her home state of Colorado. She has owned the Golden Naturopathic Clinic, LLC, since 2006. Dr Grigel lives, practices, cooks, gardens, and plays with her husband, 2 daughters, dogs, cats, and bees in Golden, CO.